Dr Marco Longoni’s CV, with all 19 pages arranged end to end, is over five-and-a-half metres or almost 7,000 words long. It opens with his formazioni – a long and precisely detailed list of qualifications that include the degree in medicine and surgery obtained with distinction at the University of Milan-Bicocca; his residency at San Gerardo Hospital in Monza; the postgraduate diploma in neurology obtained with full marks; the fellowship in Heidelberg under Dr Werner Hacke; six years carrying out neurovascular diagnostic and interventional activities at hospitals in Milan and Lecco; the diploma in radiodiagnostics from the University of of Pavia, again with full marks, and most recently a managerial training course for directors of complex structures in Romagna.
The description of his work experience is considerably longer even excluding the section on clinical care activities, which lists in detail procedures and other activities performed at hospitals throughout the Lombardy region, and since 2019 in Emilia-Romagna where he is the director of the Neurology and Stroke Unit of Cesena-Forlì.
There’s a substantial section for organizational and management activities, a long list of teaching engagements, and an even longer account of his participation in national and international courses and conferences.
All of which demonstrates that, one, Dr Longoni has been working at a furious pace for at least the past 24 years. He has excelled in everything he has signed up for, and he has kept a meticulous record of his activities and achievements – more evidence of a conscientious nature.
This comprehensive document also tells of the shift from achiever to leader five years ago, and the opportunity to combine over two decades’ worth of knowledge and experience with a management and organizational role of considerable complexity.
The Neurology and Stroke Unit Cesena-Forlì brings together in a single operating unit two neurology departments located respectively at the Bufalini Hospital in Cesena (a comprehensive centre with seven ESO Angels diamond awards) and the Morgagni-Pierantoni Hospital in Forlì. Bufalini Hospital is the referral centre for two more spoke hospitals, namely Rimini Hospital in the seaside city where the Longoni family now lives, and Santa Maria delle Croci Hospital in Ravenna.
Since 2019 Dr Longoni has modified the stroke organizational structure for the provinces Cesena-Forlì and Rimini and improved and expanded the neurological service at all three hospitals. From the start of 2021 to midway through 2022 he wore an extra hat as interim director of the Neurology Unit of Rimini, which has gone on to win a diamond award.
Serendipity
Three things happened not long after Dr Longoni assumed the role of organizational change maker. One was a serendipitous partnership with Angels who seconded his vision and provided technical support. Dr Longoni in his turn bought into the Angels philosophy, embracing the idea of measuring results and using data analysis to improve practice. Then, at the start of 2020, the Angels team in Italy together with the national steering committee and with the endorsement of the Italian Stroke Association, launched MonitorISA, the twice-yearly data collection project that is nurturing a quality monitoring culture in Italy.
Also in 2020, Covid-19 brought the healthcare system in Italy close to collapse. It was a “big mess”, Dr Longoni says but the pandemic was also an opportunity to accelerate change. In Cesena-Forlì the reorganized treatment path for stroke patients saw the establishment of the first neurology emergency room in Italy, and when the dust settled long enough for them to study the results, they realized they had improved. The neurology emergency room was there to stay.
Now that all four stroke hospitals in the network have met the criteria for ESO Angels Awards, the priorities are to stay focused, maintain progress, inculcate the same high standards in prehospital stroke care, support FAST Heroes implementation, and allow the network to thrive as a community.
“Angels always remind us to keep in touch, to have a community,” Dr Longoni says. Regional meetings among the four hospitals take place two to three times a year. “We try to have a multi-disciplinary approach. We share our best and worst cases and have conversations that could produce new ideas, new strategies, a new reset.”
A surprise twist
If by this point in our story you have formed an impression of a single-minded go-getter and overachiever, prepare to be charmed.
Marco Longoni grew up in Lecco, a small city on the southeastern shore of Lake Como. Having an older brother who was “the best at everything” spurred his competitive spirit. “I had to overcome my brother,” he says.
He also had an enquiring mind. “I was always involved in discovering something. When I got a computer, I had to look inside to see how it worked.” But his own analysis of how he arrived in the scientific field and ultimately became a neurologist ranges beyond a simple fascination with the ultimate supercomputer – the human brain.
There was also a personal – losing an 18-year-old friend to a cerebrovascular event – and a philosophical nudge towards medicine and neuroscience: “I am not only interested in how the brain works but in how beautiful the world is and how small we are in the universe.”
In their small city he and his teenage friends engaged with the philosophy of Seneca (a Stoic philosopher of Ancient Rome), an enterprise that was made easier by the simultaneous consumption of beer.
His first stint in healthcare was at the age of 16, as “a kind of a nurse” in a charitable Catholic institution in Turin. Attending to people’s basic needs including washing patients and changing catheters made him aware of another reason to become a physician – “the need to take care of someone and something”.
After 24 years of perpetual activity his management role has given him more time for his family (a unit consisting of “three children, one wife and one cat”) including the freedom to patronise the local seafood market on Saturdays and afterwards cook at home but also time on his own, exploring nature on his bicycle. He prefers two wheels to four, and “the landscape to the city”.
“I like to spend time doing nothing, being alone. I like to go on holidays in a camping car, discovering nature, being out in the open air.” (It was after all a tenet of Seneca’s that if you live in harmony with nature you will never be poor.)
Sport is important even though a joint problem means he has switched from the conviviality of football to the mindfulness of swimming. “I really appreciate swimming,” he says. “When I am swimming, I come into a trance state of mind and all that is bad falls away. After that I am new.”
One consequence of the paradigm change from team to individual sport is that it has turned him into his own opponent, forced to compete against himself.
His very surprising goal is to quit when he turns 55, a milestone seven years away, provided by then there was someone to step into this shoes who would do the work better than him, with greater energy and more power.
This momentous change would free up time for, say, “swimming a marathon or living for three months in a camper van all over Europe. I didn’t do that in my younger days, travel in Europe by train.”
Finally, since it is the apparent norm in Italy to work until you’re seventy, Dr Longoni would like to open a restaurant so he could “take care of others with food”. It should come as no surprise that he expects it to be “quite good”.
